=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841151347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NISIMOVA QUALITY FAMILY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2008 E 68TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-6010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-425-2068
-----------------------------------------------------
Fax | 929-392-1220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2008 E 68TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-6010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-425-2068
-----------------------------------------------------
Fax | 929-392-1220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | BELLA NISIMOVA
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 347-425-2068
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------